Preoperative risk factors for conversion from laparoscopic to open cholecystectomy

Abstract. – BACKGROUND: Laparoscopiccholecystectomy has become the standard treatmentfor symptomatic gallstones. However, aconversion to open surgery is sometimes still requiredto complete the procedure safely. The aimof this study is to identify the predictive factors ofconversion from laparoscopic to open cholecystectomyin both elective and emergency cases.PATIENTS AND METHODS: A retrospective reviewof all patients underwent laparoscopiccholecystectomy for symptomatic gallstonesfrom January 2011 to October 2013 was performed.Data considered for analysis were: demographicdata, comorbidities, preoperative laboratoryvalues, preoperative ERCP, indication forsurgery, and the timing of the intervention inacute cholecystitis. Conversion to open cholecystectomywas chosen as the dependent variablefor both, univariate and multivariate analysis.RESULTS: 414 patients underwent laparoscopiccholecystectomy. 245 were female (59.1%) and169 (40.8%) male, with a mean age of 51.7±16.4years. The indication for surgery was acutecholecystitis in 91 cases (21.9%). Lithiasis of thebile duct was found in 40 patients (9.6%), and itwas identified preoperatively in 37 patients, alltreated with a preoperative ERCP. Conversion toopen occurred in 33 cases (7.9%). Univariateanalysis revealed as risk factor for conversion:increased age, acute cholecystitis, comorbidities,elevated white blood cell count, increasedlevel of aspartate aminotransferase, alanineaminotransferase, alkaline phosphatase, gammaglutamyl transpeptidase, C-reactive protein, andfibrinogen. Multivariate logistic regressionanalysis showed that acute cholecystitis (OR5.63) and age > 65 years (OR 3.025) were independentpredictive factors for conversion.CONCLUSIONS: These patients should beproperly informed of their increased risk ofconversion and should be operated by surgeonsskilled in laparoscopic procedures to reducethis risk.